If anyone has any suggestions or a possible explanation for this mom's lack
of milk, I'd appreciate your input.

This is a 41 year old prime who discussed her history with me after
prenatal breastfeeding class.  She had 95% of her thyroid removed 7 years
ago for Graves' disease (hyperthyroid).  She was initially on Synthroid for
replacement but felt absolutely awful, had all kinds of symptoms until she
finally went on Armour thyroid (derived from pig thyroid).  She became
pregnant without difficulty, miscarried once, then carried this pregnancy
to term, no problems during the pregnancy.

Baby nursed vigorously in the hospital, swallowing was documented during
the feeds (including one feeding I observed), birth weight was 8-12.4 (3980
gm), discharge weight at 2 days was 8-3.7 (3735 gm).  The next day baby was
seen for a consult because mother was concerned that baby was not urinating
and becoming more lethargic.  Weight was 7-14.7 (3592 gm), mucous membranes
were dry, baby did feed well in the office but only obtained 2cc at breast,
mom pumped with an electric pump and obtained 0.  Baby was supplemented
with formula and mom preferred to pump only (not put baby to breast) so she
could see for sure what baby was getting (her choice).  During the next day
she pumped 10cc a couple of times so began putting baby to breast and
supplementing afterward.

I saw them yesterday on day 5.  Mom's breasts were soft, normal in
appearance, moderately large.  Weight was up 2 oz. in 2 days to 8-0.7 (3649
gm).  Baby latched on very well, sucked actively 10-15 minutes/side despite
poor swallowing, total intake was 6cc.  By her description her milk
apparently came in the day before, breasts were heavier and lumpy at that
time.  Reglan (metoclopramide) 10 mg 3x/day was started and the amount of
supplemental formula was increased.

Mom is on no meds other than the thyroid and prenatal vitamins.  She noted
no breast enlargement during her pregnancy.  Many years ago she had a
workup at Mayo clinic for hirsutism but no explanation was found.  There is
a family history of polycystic ovary syndrome but she was told that she did
NOT have this.  My understanding is that the thyroid removal should have no
effect on milk production since appropriate thyroid hormone levels are
being maintained.  Am I correct?  If the hirsutism was from high levels of
androgens (speculation), could this be affecting her milk supply without
having had an effect on the pregnancy?  Thanks for any input.

Becky Krumwiede, RN, IBCLC, Appleton, Wisconsin
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